Gabapentin shingles
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Gabapentin for Shingles: Efficacy in Acute Pain and Postherpetic Neuralgia
Introduction to Shingles and Pain Management
Shingles, also known as herpes zoster, is a reactivation of the varicella-zoster virus, which causes chickenpox. It manifests as a painful, unilateral rash that typically resolves on its own. However, the pain associated with shingles can begin before the rash appears and may persist long after the rash has healed, leading to a condition known as postherpetic neuralgia (PHN)1 2.
Gabapentin for Acute Shingles Pain
Limited Research on Acute Phase Efficacy
While gabapentin is widely prescribed for chronic pain associated with herpes zoster, its efficacy during the acute phase of the disease has not been thoroughly investigated. The current literature primarily focuses on its use for chronic pain management rather than immediate pain relief during the initial outbreak of shingles1.
Gabapentin for Postherpetic Neuralgia (PHN)
Proven Efficacy in Reducing Chronic Pain
Gabapentin has been extensively studied for its effectiveness in treating PHN, a common and debilitating complication of shingles. Clinical trials have demonstrated that gabapentin significantly reduces pain, improves sleep quality, and enhances certain parameters on the Short Form-McGill Pain Questionnaire2. These benefits make gabapentin a valuable option for managing the chronic pain associated with PHN.
Dosage and Tolerability
The recommended dosage of gabapentin for PHN starts at 300 mg at bedtime on the first day, increasing to 300 mg twice daily on the second day, and 300 mg three times daily on the third day. The dosage can be titrated up to 2400-3600 mg per day as needed. Gabapentin is generally well-tolerated, although common side effects such as dizziness and somnolence can lead to withdrawal from treatment in some cases2.
Pharmacokinetics and Safety
Gabapentin displays nonlinear absorption kinetics and is minimally protein-bound. It has a high volume of distribution and is excreted unchanged via the kidneys. For patients with renal impairment, dosage adjustments based on creatinine clearance are necessary to minimize adverse effects2.
Conclusion
Gabapentin is a well-established treatment for the chronic pain associated with postherpetic neuralgia, offering significant pain relief and improved quality of life for patients. However, its efficacy in managing acute pain during the initial phase of shingles remains under-researched. Further studies are needed to explore gabapentin's potential benefits during the acute phase of herpes zoster and to compare its effectiveness with other pharmacologic agents used for PHN.
By understanding the current research landscape, healthcare providers can make informed decisions about incorporating gabapentin into treatment plans for patients suffering from shingles and its complications.
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Most relevant research papers on this topic
Does acute pain associated with herpes zoster respond to treatment with gabapentin?
Gabapentin may be effective in relieving acute pain associated with herpes zoster, but its effectiveness during the chronic postherpetic neuralgia phase remains unclear.
The use of gabapentin for the treatment of postherpetic neuralgia.
Gabapentin is an effective and well-tolerated short-term treatment for postherpetic neuralgia, reducing pain and improving sleep, but may cause dizziness and somnolence.
Systematic ReviewGabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial.
Gabapentin effectively reduces pain and sleep interference in postherpetic neuralgia patients, improving mood and quality of life.
RCT
Highly CitedMemantine as a Potential Therapy in Subacute Herpetic Neuralgia: A Randomized Clinical Trial
Memantine combined with Gabapentin effectively reduced the severity of subacute neuropathic herpes zoster and is expected to be a viable option for treating and relieving subacute and chronic nerve pain.
RCTNotes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths — 23 States and the District of Columbia, 2019–2020
Gabapentin-related overdose deaths in 23 states and the District of Columbia increased by 5% from 2018 to 2019, with a higher incidence in unintentional or undetermined cases compared to the previous year.
Varicella zoster virus induces neuropathic changes in rat dorsal root ganglia and behavioral reflex sensitisation that is attenuated by gabapentin or sodium channel blocking drugs
Varicella zoster virus infection in rats leads to neuropathic changes and behavioral reflex sensitisation, which can be reversed by gabapentin or sodium channel blockers.
Non-RCT
Animal StudyHighly CitedPost-herpetic Neuralgia: a Review
Post-herpetic neuralgia (PHN) is a chronic neuropathic pain condition that persists for 3 months or more after shingles, with various medications and treatments being effective.
Highly CitedStability of gabapentin in SyrSpend SF.
Gabapentin in SyrSpend SF, a non-alcoholic oral solution, maintains its stability for at least 90 days when refrigerated or stored at room temperature and protected from light.
Cost-effectiveness of a lidocaine 5% medicated plaster relative to gabapentin for postherpetic neuralgia in the United Kingdom.
The lidocaine 5% medicated plaster is a cost-effective alternative to gabapentin for postherpetic neuralgia patients intolerant to tricyclic antidepressants and in need of pain relief.
Observational StudyChange in opioid use after the initiation of gabapentin therapy in patients with postherpetic neuralgia.
Initiation of gabapentin therapy in patients with postherpetic neuralgia leads to a significant reduction in opioid analgesic use.
Observational Study